Abuse of attention deficit pills moves into the workplace

By Alan Schwarz, New York Times

April 20, 2015

Photo: Elizabeth D. Herman /New York Times

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Elizabeth, a Long Island native in her late 20s, with the Adderall pills she considers a necessity to keep pace with her peers. Interviews with users and treatment experts suggest a growing number of young American workers are taking stimulants to enhance concentration and stamina at work. less

Elizabeth, a Long Island native in her late 20s, with the Adderall pills she considers a necessity to keep pace with her peers. Interviews with users and treatment experts suggest a growing number of young ... more

Photo: Elizabeth D. Herman /New York Times

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Interviews with users and treatment experts suggest a growing number of young American workers are taking stimulants to enhance concentration and stamina at work.

Interviews with users and treatment experts suggest a growing number of young American workers are taking stimulants to enhance concentration and stamina at work.

Photo: Michael Stravato /New York Times

Abuse of attention deficit pills moves into the workplace

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Fading fast at 11 p.m., Elizabeth texted her dealer and waited just 30 minutes for him to reach her third-floor New York apartment. She handed him a wad of twenties and fifties, received a tattered envelope of pills and returned to her computer.

Her PowerPoint needed another four hours. Investors in her health-technology startup wanted recrunched numbers, a presentation begged for bullet points, and emails from developers, from all points global, would keep arriving well past midnight.

She gulped down one pill — pale orange, like baby aspirin — and then, reconsidering, took one of the pinks, too.

“OK, now I can work,” Elizabeth exhaled. Several minutes later, she felt her brain snap to attention. She pushed her glasses up her nose and churned until 7 a.m. Only then did she sleep for 90 minutes, before arriving at her office at 9.

The pills were versions of the drug Adderall, an amphetamine-based stimulant prescribed for attention deficit hyperactivity disorder that many college students have long used illicitly while studying. Now, experts say, stimulant abuse is graduating into the workforce.

Reliable data to quantify how many U.S. workers misuse stimulants does not exist, several experts said.

But in interviews, dozens of people in a wide spectrum of professions said they and co-workers misused stimulants such as Adderall, Vyvanse and Concerta to improve work performance. Most spoke on the condition of anonymity for fear of losing their jobs or access to the medication.

Doctors and medical ethicists expressed concern for misusers’ health, as stimulants can cause anxiety, addiction and hallucinations when taken in high doses. But they also worried about added pressure in the workplace — where the use by some pressures more workers to join the trend.

“You’d see addiction in students, but it was pretty rare to see it in an adult,” said Dr. Kimberly Dennis, the medical director of Timberline Knolls, a substance-abuse treatment facility for women outside Chicago.

“We are definitely seeing more than one year ago, more than two years ago, especially in the age range of 25 to 45,” she said.

Elizabeth, a Long Island native in her late 20s, said that to not take Adderall while competitors did would be like playing tennis with a wood racket.

“It is necessary — necessary for survival of the best and the smartest and highest-achieving people,” Elizabeth said. She spoke on the condition that she be identified only by her middle name.

Most users who were interviewed said they get pills by feigning symptoms of ADHD, a disorder marked by severe impulsivity and inattention, to physicians who casually write prescriptions without proper evaluations. Others get them from friends or dealers.

Obtaining or distributing stimulants without a prescription is a federal crime, but the starkest risks of abuse appear to be overdose and addiction.

A 2013 report by the federal Substance Abuse and Mental Health Services Administration found that emergency room visits related to nonmedical use of prescription stimulants among adults 18 to 34 tripled from 2005 to 2011, to almost 23,000.

The agency also reported that from 2010 to 2012, people entering substance rehabilitation centers cited stimulants as their primary substance of abuse 15 percent more often than in the previous three-year period.

Just how stimulants such as Adderall might improve work performance, and to what extent, remains a matter of scientific debate.

But many young workers insist that using the drugs to increase productivity is on the rise — and that these are drugs used not to get high, but hired.

“Given the increase in rates of abuse in college students over the last decade, it is essential that we understand the outcomes as they leave college and assume adult roles,” Dr. Wilson Compton, the deputy director of the National Institute on Drug Abuse, said in an interview.

Researchers in the field are quick to caution that, despite stimulants’ reputation as “smart pills,” few studies suggest that they improve a person’s ability to learn or understand. But they often improve attention and motivation, particularly for tedious tasks, which can increase productivity — or at least the appearance of it.

Some industries have banned the use of stimulants for reasons of safety or fairness. The Federal Aviation Administration forbids pilots to use the medications under any circumstances. Major League Baseball players and other athletes had long abused amphetamines to increase focus and endure exhausting travel schedules, but the drugs are now considered performance-enhancers and are allowed only with a confirmed ADHD diagnosis.

Interviews with people who misuse the pills show that the users are a diverse group. A dentist in eastern Pennsylvania prescribed herself Adderall and other stimulants for years because, she said in a telephone interview, she could see 15 patients a day rather than 12.

Lisa Deese of Fishers, Indiana, said she had abused Adderall as a stay-at-home mother of three for years. The pills, she said, “were like mommy crack.”

“I got so much more done during the day,” she added. “I was hooked by my first pill.”

While many studies have assessed the prevalence of misuse among college students, no doctor or researcher contacted for this article could cite a formal assessment of misuse among adults to improve job performance.

But Dr. Anjan K. Chatterjee, the chairman of neurology at Pennsylvania Hospital in Philadelphia and an expert in the field of cognitive enhancement, said that even without conclusive data, misuse was undoubtedly rising. “Kids who have been using it in high school and college, this is normalized for them,” Chatterjee said. “It’s not a big deal as they enter the workforce.”

One indicator of the problem is that supply has risen sharply: About 2.6 million American adults received ADHD medication in 2012, a rise of 53 percent in only four years, according to Express Scripts, the nation’s largest prescription-drug manager. Use among adults 26 to 34 almost doubled.